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Phillip Tutor: Counting the remdesivir vials at RMC

073020_Alexandria COVID testing_005 tp.jpg

The Calhoun County Health Department conducted free drive-thru COVID-19 testing at Alexandria Elementary School Thursday morning. (Photo by Trent Penny/The Anniston Star)

Remdesivir isn’t a cure for COVID-19, can’t prevent anyone from contracting the disease and provides no survival guarantees. Plus, it’s alarmingly expensive. 

“It’s not a miracle drug,” Dr. Raul Magadia, Regional Medical Center’s infection control chair, said Thursday morning. “It’s not a home run.”

But it is something, a glimmer, which in a pandemic is better than the grotesque alternative. “It is hope,” he said. And he wants more of it.

If only it were that easy.

Before the pandemic Magadia didn’t sweat the hospital’s medication stockpile. Why would he? It was like air, always there. An afterthought.

But worldwide demand for remdesivir — an antiviral drug that can reduce the length of hospital stays for the sickest COVID-19 patients by about 30 percent — has stressed the supply chain and worried doctors that, until a vaccine is developed, procuring remdesivir is an addendum to their jobs.

Thursday is medication order day at RMC, so earlier this week Magadia asked the hospital’s pharmacy to request 20 courses of remdesivir from the drug’s distributor. (A “course” is a five-day regimen given to coronavirus patients who meet criteria similar to those of ventilator patients.) 

RMC, though, isn’t likely to get 20 courses; it may only get four or five, Magadia said, as the Pennsylvania-based distributor, AmerisourceBergen, divvies out a dwindling remdesivir supply to hospitals in all 50 states. 

I know; that’s either absurd or astonishing, if not both. 

Magadia likens remdesivir to a “drug that was just waiting for a job” before the pandemic. Made by California-based Gilead Sciences, remdesivir had been mildly effective against the SARS coronavirus outbreak in 2003 but had provided little usefulness against ebola outbreaks. It was, he said, just sitting in the lab.

COVID-19’s arrival spurred doctors to give the antiviral medication another chance. The sickest patients given remdesivir who survived tended to have shorter hospitalizations than those who didn’t get that medication. Demand for remdesivir soared.

This is where Magadia’s explanation veers from medicine to supply-chain economics. Gilead still owns the remdesivir patent and controls production. Strict Food and Drug Administration regulations originally prevented remdesivir use on coronavirus patients without emergency exceptions. After changes to those guidelines Gilead donated 120,000 courses — more than 940,000 vials — of remdesivir in late spring for the federal government’s COVID-19 response.

RMC received five courses of that 120,000.

“New York gobbled up the majority of that really fast,” Magadia said. 

That nationwide cache ran out two weeks ago, and the federal government in late June brokered a deal with Gilead to get another 500,000 courses — priced at $3,200 a pop. AmerisourceBergen is the drug wholesaler partnering with state health officials to oversee distribution.

But here’s the catch: Those 500,000 courses are nearly all of Gilead’s production through September; after that, it’ll be out until it makes more, and that’s a months-long process. It’s also a frightening thought considering more than 150,000 Americans have already died from the disease. And Gilead is supplying remdesivir to the planet, not only the United States.

For now, RMC’s remdesivir stockpile is manageable — though AmerisourceBergen allows orders only one week at a time, and then doctors aren’t sure how many vials they’ll receive. “We’re not UAB, we’re not Emory,” Magadia said. Larger hospitals like those get more doses; hospitals in hot spots are prioritized. “They don’t want you hoarding it.”

Magadia has had no choice but to be medically judicious in deciding which patients get the medication. Manageable coronavirus symptoms alone — fever, headache, nausea, chills — don’t qualify. No one gets it if they’re not hospitalized because it’s given by IV. Seventeen patients thus far have received it at RMC, he said; six were on it Thursday.

But Magadia is aware of what’s happening elsewhere. Like in hard-hit Florida, where hospitals have begged the governor to help them find more antiviral courses. Like in Arizona and Texas, where hospital shortages are a reality. And like in India, where remdesivir is being sold for exorbitant prices on the black market to both doctors and patients’ families. 

As of Thursday afternoon the coronavirus had sickened 4.54 million people in the United States — including 84,000 in Alabama — and killed 154,000. Calhoun County’s numbers won’t stop rising: 1,300-plus confirmed cases, eight deaths. 

And if there’s a severe remdesivir shortage this fall? What happens then? 

“This is the distinct possibility that I dread because there’s only 500,000 courses,” Magadia said. “In the United States alone, I think you are probably going to see a lot of people resorting to the black market and all those things. 

“It’s dreadful. I shudder to think of that possibility. It might happen.”

Phillip Tutor — ptutor@annistonstar.com — is a Star columnist. Follow him at Twitter.com/PTutor_Star.

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